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Home My WebLink About4000-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P.E:RTIFIP-ATE: OF OB~UPANr. y No.~...3.3.3..2 ..... Date ... ~. ii, ............... 19.68. THIS CERTIFIES that the building located at 1~/~1 .l~ta~hla~l~;./~v.$, ........ Street Map No ............. Block No ............. Lot No .... .~.~.~[~1~:,..~.~q. ~..C}~k. ....... conforms substantially to the Applicati. on for Building Permit heretofore filed in this office dated ...... ~I~$K ..1,6, .... , 19.68. pursuant to which Building Permit No. &00Il .Z. dated ...... .~.t[~.~:...$;1.,. .... , 19~.., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The occupancy f~or which this certificate is issued is ..... p.~;t.v.l[~;l~ .o~ae. ~,a~alJ.~r. ~-1111~9 ...................................... The certificate is issued t.o .. 1~,. &.][~$ o. ~:1~. P~ef~e:[,..$~ .................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval J[~(:~ml~:..4~. ],96~. ~,O~:..~iL].&. Building Inspector / FORM NO. 2 TOWN OP $OOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 000 Z Permission is hereby gronted to: at premises located at .......~J~.~.....~.t..&.~.el ......................................................................... ................................................ .(t~'.e ~,p~'.t, ....... }/~. ......................................................................... pursuon¢ to opplicotion doted ...................... ~1~ ......... .1.~. ............... , 19..~.., ond opproved by the Building Inspector. ~O,~gI Pe:~a~t ~O8tllld sub~eet t~o ~eqgS~'ed s®tbeekl & ~eq~nt of bou~g e~e Fee $..1.0~0 .......... ~uilding Inspector/ S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date / ~/~F Bldg, Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give seed location) have been inspected by this department and found to be satisfactory. Examined ,, " /4000 Approved ........................................ , 19 ........ Permit No ............................. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c .................................................................... (Buildir~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a/ ~ This aP01ication must be dompletely filled in by typewriter or' n hk arid Subm Jte~ in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a deCailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of/a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ..... T~r,~.~.I)...~.0]~... Z]LCCL .~......~..~~ ..... (Signature of applicant, or name,~if a corporatio~ .o. .¢..L .e. ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................... .G***..gSa. ~.T.:..(lO,,'Yl't~q ~,O.R. .................................................................................. Name of owner of premises ..... .,]~. -.'~.~.a.`.`.`.`.`.`.`.`~..~.~..~.~....]~.~..~.~.~...~.~.~`.e..~.*~*. ................................................................ If applicant is o corporate, signature of duly authorized officer. ................................................................................. ...~...e..~..~... (Nome and title of corporate officer) 1. Location of land on whi. ch proposed work will be done. Map No~et~.g~J,]~.P.~...],.~,l~.~ ........ Lot NO.: ........................ Street and Number J: .~ ................ ~...I~.e.~.;IK....g:.;RP.~/:~9.X.~.~.....])~...~. ...... ~ . Municipality 2. State existing use and eccupancy of premises and intended use"cMd occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ...................... .D..~ .~...]~J~..~.......(.~.~.~/;I,.O..~.) ....................................................... 3. Nature of work (check which applicable): New Building ....... ~.... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... .~.]....~..,~..~.0..0.~..0..0. ............................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .0..q.~. ............... Number of dwelling units on each floor ............................ If garage, number of cars ...........O...~..e. ............................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ~...../dT....~...~. ...... Rear .....~........~...~...I... Depth ..~...~..!..8.~ .......... Height .....J~ ........Number of Stories ........ .0l~ ...................................................................................................... 9. Size of lot: Front ....... 0.,~.~..0. ........... Rear ...... ~..~.].e..8...O....! ........... Depth ....~.~..~.u...1..a..E.:.....1.25e29/l~l.$5 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construc'tio;4 V~016t~ any~ ZOning law, ordinance or regulation? ........ ,,'~.0. .............................................. 13. Name of Owner of premises ...~..~.~.~...~'......l~....e..~...~.~..~.....~-cldress ...Z...8~.,...t$.9....~.~.~..8..t;..~. ..... Phone No ..................... Name of Architect ...................................................... Address.....T'A'nd'ez~hu'~....... ............. ~ ~°...... Phone No ..................... Name of Contractor~...z~...~..~.~.....~...O..m...e..a....~.q.* ............ Address ......8...~..],.~e.~.....I~...9. ............ Phone N~.-3...~.~..~...~.~..~. .... ~ ~ PLOT DIAGRAM Locate clearly and distinctly a~l I~ildings, whether existing or propibsed, and indicate all set-back dimensions from property lines. Give street and bl6ckinumber or description accordinl~ to deed, end show street names and ndicate whether interior or corner lot. i ~ ~ ~-.~ y~ ~ STATE OF NE'~ Y.,QRK. },ce COUNTY .............. ..]i.ob.~:r.t~..le,,..~]~ .............................................. : ...... .q... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~>A~.f~$.~`~..~.~.~...~.~.~...~..a..~:..~.~..~..~..m..~.~...~`~..~....C~n~q~) .............................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .... '_,